Viral Diarrhea (Infant/Toddler)

Outline of infant showing digestive system.

Diarrhea caused by a virus is called viral gastroenteritis. Many people call it the “stomach flu,” but it has nothing to do with influenza. This virus affects the stomach and intestinal tract. It usually lasts 2 to 7 days. Diarrhea means passing loose watery stools 3 or more times a day.

Your child may also have these symptoms:

  • Abdominal pain and cramping

  • Nausea

  • Vomiting

  • Loss of bowel control

  • Fever and chills

  • Bloody stools

The main danger from this illness is dehydration. This is the loss of too much water and minerals from the body. When this occurs, body fluids must be replaced. This can be done with oral rehydration solution. Oral rehydration solution is available at drugstores and most grocery stores. Sports drinks are not equivalent to oral rehydration solutions. Sports drinks contain too much sugar and too few electrolytes.

Antibiotics are not effective for this illness.

Home care

Follow all instructions given by your child’s healthcare provider.

If giving medicines to your child:

  • Don’t give over-the-counter diarrhea medicines unless your child’s healthcare provider tells you to.

  • You can use acetaminophen or ibuprofen to control pain and fever. Or, you can use other medicine as prescribed.

  • Don’t give aspirin to anyone under 18 years of age who has a fever. This may cause liver damage and a life-threatening condition called Reye syndrome.

Your child is considered contagious for as long as he or she has diarrhea. To prevent the spread of illness:

  • Remember that washing with soap and water and using alcohol-based sanitizer is the best way to prevent the spread of infection.

  • Wash your hands before and after caring for your sick child.

  • Clean the toilet after each use.

  • Dispose of soiled diapers in a sealed container.

  • Keep your child out of day care until he or she is cleared by the healthcare provider.

  • Wash your hands before and after preparing food.

  • Wash your hands and utensils after using cutting boards, counter-tops and knives that have been in contact with raw foods.

  • Keep uncooked meats away from cooked and ready-to-eat foods.

Giving liquids and feeding

The main goal while treating vomiting or diarrhea is to prevent dehydration. This is done by giving small amounts of liquids often. Liquids are the most important thing. Don’t be in a rush to give food to your child.

If your baby is breastfed:

  • Keep breastfeeding. Feed your child more often than usual.

  • If diarrhea is severe, give oral rehydration solution between feedings.

  • As diarrhea eases, stop giving the rehydration solution and go back to your normal breastfeeding schedule.

If your baby is bottle-fed:

  • Give small amounts of fluid at a time, especially if your child is vomiting. An ounce or two (30 to 60 mL) every 30 minutes may improve symptoms. Start with 1 teaspoon (5 mL) every 5 minutes and increase gradually as tolerated.

  • Give full-strength formula or milk. If diarrhea is severe, give oral rehydration solution between feedings.

  • If giving milk and the diarrhea is not getting better, stop giving milk. In some cases, milk can make diarrhea worse. Try soy or rice formula.

  • Don’t give apple juice, soda, or other sweetened drinks. Drinks with sugar can make diarrhea worse.

  • If your child is doing well after 24 hours, resume a regular diet and feeding schedule.

  • If they start doing worse with food, go back to clear liquids.

If your child is on solid food:

  • Keep in mind that liquids are more important than food right now. Don’t be in a rush to give food.

  • Don’t force your child to eat, especially if he or she is having stomach pain, cramping, vomiting, or diarrhea.

  • Don’t feed your child large amounts at a time, even if your child is hungry. This can make your child feel worse. You can give your child more food over time if he or she can tolerate it.

  • Give small amounts at a time, especially if the child is having stomach cramps or vomiting.

  • If you are giving milk to your child and the diarrhea is not going away, stop the milk. In some cases, milk can make diarrhea worse. If that happens, use oral rehydration solution instead. This sensitivity to milk usually resolves as the intestine heals.

  • If diarrhea is severe, give oral rehydration solution between feedings.

  • If your child is doing well after 24 hours, try giving solid foods. These can include cereal, oatmeal, bread, noodles, mashed carrots, mashed bananas, mashed potatoes, applesauce, dry toast, crackers, soups with rice noodles, and cooked vegetables.

  • For a baby over 4 months, as he or she feels better, you may give cereal, mashed potatoes, applesauce, mashed bananas, or strained carrots, during this time. A baby over 1 year may have crackers, white bread, rice, and other complex starches, lean meats, yogurt, fruits, and vegetables. Low fat diets are easier to digest than high fat diets.

  • If your child starts doing worse with food, go back to clear liquids.

  • You can resume your child's normal diet over time as he or she feels better. If the diarrhea or cramping gets worse again, go back to a simple diet or clear liquids.

Follow-up care

Follow up with your child’s healthcare provider, or as advised. If a stool sample was taken or cultures were done, call the healthcare provider for the results as instructed.

Call 911

Call 911 if your child has any of these symptoms:

  • Trouble breathing

  • Confusion

  • Extreme drowsiness or trouble walking

  • Loss of consciousness

  • Rapid heart rate

  • Chest pain

  • Stiff neck

  • Seizure

When to seek medical advice

Call your child’s healthcare provider right away if any of these occur:

  • Abdominal pain that gets worse

  • Constant lower right abdominal pain

  • More than 8 diarrhea stools within 8 hours

  • Continued severe diarrhea for more than 24 hours

  • Blood in stool

  • Refusal to drink or feed

  • Dark urine or no urine for  or dry diaper for 4 to 6 hours, no tears when crying, sunken eyes, or dry mouth

  • Fussiness or crying that can’t be soothed

  • Unusual drowsiness

  • New rash

  • Diarrhea lasts more than 1 week on antibiotics

  • Fever (see Fever and children, below)

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.

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